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Potter on PPACA: Consumer Reps Feel Outnumbered

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Consumer group representatives feel as if they are outnumbered 100 to 1 when they talk to Obama administration officials about implementation of the Affordable Care Act, according to Wendell Potter.

Potter spent 15 years working in the public relations operation at CIGNA Corp., Philadelphia (NYSE:CI). He now writes about health insurance for the Center for Public Integrity, Washington.

Potter gives efforts to implement the patient appeals section of the Patient Protection and Affordable Care Act of 2010 (PPACA), a major component of the Affordable Care Act package, as an example of what consumer group reps believe is insurers’ ability to outinfluence the consumer groups.

The National Association of Insurance Commissioners (NAIC), Kansas City, Mo., developed a draft version of the regulation, which originally was set to take effect July 1, 2011.

“The NAIC got its work done comparatively swiftly,” Potter writes in a new column on the Center for Public Integrity’s website.

Officials in the Obama administration have taken a long time to complete its work on finalizing the regulations, and they seem to be indicating that they will give insurers until Jan. 1, 2012, to comply with the new rules, Potter says.

“Consumer advocates who have been in meetings at the White House in recent weeks say they believe the administration is bending over backward to accommodate the insurers,” Potter says. “They expressed concern that the final regulations would allow insurers to stack the decks against patients by allowing health plans to deem a second-level internal appeal of a denial as meeting the requirement for an independent external appeal.”

One challenge is that many journalists who covered the original PPACA debates have moved on or have little interest in covering the writing of regulations, Potter says.

“Insurance company lobbyists know the media are not paying much attention,” Potter says. “And so they are able to influence what the regulations actually look like–and how the law will be enforced–with little scrutiny, much less awareness.”

- Allison Bell

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